Provider Demographics
NPI:1124119623
Name:LOLLAR, MARK WILLIAM LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM LEE
Last Name:LOLLAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5201 NORRIS CANYON RD
Mailing Address - Street 2:#310
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-327-1500
Mailing Address - Fax:925-327-1900
Practice Address - Street 1:5201 NORRIS CANYON RD
Practice Address - Street 2:#310
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5406
Practice Address - Country:US
Practice Address - Phone:925-327-1500
Practice Address - Fax:925-327-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-08-13
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Provider Licenses
StateLicense IDTaxonomies
CAA50219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502190Medicare ID - Type Unspecified
F49986Medicare UPIN